The Blues Is Depression. Should You Treat It With Pills?

What people refer to as the blues is usually depression.  Depression, or the blues, is an unpleasant emotional state characterized by what therapists refer to as “the negative cognitive triad.”  That’s 1) negative thoughts about oneself, which are the voices of your inner critic harping on you for what you supposedly have done wrong, should have done differently, and on and on 2) negative thoughts about others that lead you to see what you don’t like in them instead of heeding their virtues and enjoying them, creating relationship problems and 3) negative thoughts about the future.

Some people describe the blues, and also depression, as feeling like there’s a dark cloud over you.  Others refer to depression as seeing the world through dark glasses.  Feelings of hopelessness and helplessness are another indicator.

How can you get rid of your blues and your inner critic by treating the underlying depression?

There are four main strategies:

  1. Change your feelings.Take pills or use one of the newer treatment methods that change your bluesy mood by changing your inner body chemistry and brain functioning.
  2. Change your thoughts.  Eliminating the inner critic may get rid of the depressed, bluesy feelings.
  3. Change your actions. Get exercise.  Go out and be with people.  Express more gratitude.  Do acts of kindness.
  4. Identify and address the problem that initially triggered your depressed feelings and thoughts.  Find a new solution and both the negative feelings and the negative thoughts will evaporate.

Why do people take antidepressant medications?

There are four main reasons why people who may be distressed by something in their lives end up defining their depression as an illness and taking medication.

First and foremost, depression is a terrible feeling that sufferers sorely want to get rid of.

Second, most folks have not been fully informed of the medications’ downsides. I’ll elaborate on drug dependency below.  In addition, these medications can cause serious weight gain, a significant drop in libido (ability to enjoy sex), hazy thinking, and a general emotional numbness that blocks feelings of joy in addition to feelings of depression.

Third, people who take the medications may not have been informed of their relatively low rate of effectiveness.  They can be effective if they work, but they only work for something like about 60% of people who use them.

Fourth, most people who take anti-depressant medications have not been informed by their doctor about alternative treatment options.  To a man with a hammer, the world is a nail.  Physicians know about illness and prescribe medications.  As psychologist Martin Seligman has explained, depression is a relatively normal, if quite unpleasant and often self-defeating, response of giving up in response to a challenging life circumstance.

What are the downsides of assuming that depression is an illness and therefore needs pills? 

As mentioned above, two particularly negative side effects of medication that doctors do not sufficiently explain include potential weight gain and decreases inability to experience sexual arousal. Doctors may mention them but often do not clarify that both extra pounds and decreased interest in sex can have strongly negative impacts on personal self-esteem, on attracting a mate and on sustaining a marriage.

The other significant risk that doctors may or not fully explain is that users may have a hard time getting off these medications.  When a drug company says that their anti-depressant medication is not addictive, strictly speaking, they are telling the truth.  A strict clinical definition of an addictive substance or activity is one that induces both dependency and craving.  Antidepressants do not induce craving.  Over time they do, however, make users drug dependent.

Craving is a familiar feeling to anyone who has fallen in love.  The intense sexual desire that drives someone in love to find every way possible to be near the object of their desire is a craving.  Someone who craves alcohol similarly may wake up in the morning already urgently wanting a drink.

What does “drug dependent” mean?   Drug dependency is the state a body goes into when it has adapted to the presence of a chemical to the point that the body requires steady doses of the substance to maintain normal functioning. We are all, for instance, chemically dependent on water.

Our society is highway-dependent.  Many of us have become accustomed to having highways that enable us to drive to work from the suburbs.  Having bought a house in the suburbs on the assumption that we can take the highway to work, we have become highway dependent.  It’s unlikely that anyone has a craving for highways.  Many of us though have become highway dependent.

If you for some time have been taking an antidepressant medication, the odds are that your body has become drug dependent.  That means that if you should decide today that as of tomorrow you will no longer take the medication, starting tomorrow, you are likely to discover that without the pills that you normally take your body will plunge into a serious depressive state.

Does this depression mean that you need after all to stay on your meds because the pills are all that have stood between you and the depths of despair?   Not at all.  To the contrary, this depression means that your body has become dependent on the antidepressant pills.  Is this addiction?  No, but it is drug dependency.

I am not saying that no one should ever take antidepressant medication.  They do help some people.  Some people experience relatively few to zero negative side effects.  My point is just that if you are considering taking these medications, or have for some time been using them, you deserve accurate information about the factors to take into account in your decision, including information about other treatment options.

Here are six vital points to consider.

1) There now are multiple excellent alternatives to medication for working your way out of depression, including various kinds of talk therapies such as CBT, energy therapies such as Bradley Nelson’s Emotion Code and Body Code, acupuncture, exercise, electrical stimulation of the brain, the visualization you can download for free from my website, or read about how to do on one of my other blogposts, couples therapy, and more.

2) Depression is induced by a situation in which you have experienced insufficient power. If you close your eyes and picture whom or what you may feel angry at, you will see an image of the trigger person or situation. Fix that situation, and your depression will be likely to go away.

3) If your doctor is recommending medication as a short-term fix, use the pills until you feel better. Use your renewed energy to address the power-loss situation. Then begin the medication-weaning process asap.

4) Wean slowly. Consult your prescribing doctor for an appropriate weaning schedule for the particular medication that you are taking.

5) Be aware that research has shown that the most powerful way to overcome depression and keep it far from you, in the long run, is the combination of therapy and medication. Medication alone and psychotherapy alone have very similar effectiveness rates, but medication has an impact more quickly, and psychotherapy tends to have more longer-lasting impacts.

6) There is a visualization exercise that you can do with a therapist, a friend, or on your own that may help you conquer the depression in just a few minutes.  See my posting on A New Treatment for Depression.

6) In my clinical experience, I find that most depression is a response to relationship problems. Look into marriage educationcouples counseling, or a combination of both to upgrade your relationship. These treatment routes can make you a double winner.  You can both end the depression and simultaneously gain a vastly more gratifying marriage or romantic partnership.

Susan Heitler, Ph.D., a Denver Clinical psychologist, is an author of multiple publications including From Conflict to Resolution for therapists, The Power of Two and for couples who want to strengthen their relationship. Dr. Heitler’s most recent book is Prescriptions Without Pills, with a free companion website at


How Standing Up For Yourself Helps You Fight Depression


Depression the most common mental health disorder in the United States with nearly one in 10 U.S. adults experiencing some form of it. Depression is affecting younger and younger generations, and sadly, it is on the rise. According to the World Health Organization, by the year 2020, depression will be the second most common health problem in the world. With October being Depression Awareness Month, I’m probably not the first to bring this subject to your attention, but what if we took pause to think about what these numbers really mean?

Once we recognize the real impact of depression, not just on a broader world health level, but on the individual lives that it affects every day, we must abolish whatever remains of the stigma that depression is something to be ashamed about, or that it’s just a bad mood, so “snap out of it.” And we must start thinking about what works in terms of treatment, a subject I’ll talk more about in a free Webinar “Empowering Strategies to Fight Depression.” How can each of us take up arms against this painful condition and offer ourselves, our children, and our loved ones their best chance at overcoming depression?

When it comes to finding ways to empower ourselves against depression, I believe that one of the most important things to consider is the effect of the “critical inner voice.” The critical inner voice represents a damaging internal thought process, a form of destructive self-talk that perpetuates feelings of shame, self-hatred, negative rumination, and low self-esteem. Studies have shown that low self-esteem predicts depression. Even in toddlers, a negative self-concept has been found to be associated with depression.

Although, most of us experience low self-esteem and are familiar with the commentary of a critical inner voice, for those who are depressed, this critical inner voice can have a powerful, debilitating influence on their state of mind. The critical inner voice can cause people to dwell on perceived problems or sorrows. It can also make it even more difficult to take actions that would help individuals emerge from a depressive state. This voice is often critical and highly distorted. In a blink of an eye, it can fill our heads with thoughts like: “You’re so pathetic. You’re just a drain on everyone. You’re worthless/ stupid/ ugly. Why can’t you just be normal? You don’t really have anything to look forward to. There’s nothing to feel good about.”

The critical inner voice is also tricky, as it can seem both self-soothing and self-punishing. It lures us into engaging in actions or situations that then perpetuate our anxiety and depression. “Just go home and be by yourself,” it suggests.  “You should just have a drink and relax. There’s no point in trying to be active. Why go through all the trouble of going out and seeing those people?” When we give in to these “voices,” our inner critic is then there to punish us. “What’s the matter with you? All alone again. What a loser. You never succeed at anything. No one wants you around anyway.”  This type of cyclical thinking turns us completely against ourselves and leaves us at the mercy of a mean and ruminating inner enemy. To combat depression means taking on this inner voice or “anti-self.”

My father, Dr. Robert Firestone, created Voice Therapy as a therapeutic approach to conquer your critical inner voice, and in our book of that tile, which I co-authored with my father, we discuss specific ways people can start to challenge this inner enemy. Here are some of the valuable steps that can help people to start to recognize and counter these destructive thought processes.

  1. Identify the negative thoughts and beliefs you experience. Notice the events and circumstances that trigger these “voices” and the feelings that arise.
  2. Write the thoughts down in the second person as if someone is talking to you. So, instead of writing “I don’t have anything to offer,” write “You don’t have anything to offer.” This allows you to shift perspective and see the voice as an external enemy instead of your own point of view.

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  1. Respond rationally and compassionately to these “voices,” as you would to a friend, except this time, write your responses in the first person, as “I” statements. “I have a lot to offer. I have many qualities that people appreciate, and I care about others. I am fine the way I am.”
  2. Talk to a close friend who tends to have a more optimistic outlook. This can help you align with your real self and counter the negativity of your anti-self.
  3. Make yourself engage in activities that you have enjoyed in the past. Even if you don’t feel like it right now, taking these actions will help reinvigorate you and interrupt the destructive thought process that’s taking place.

One of the most important principles you can adopt in facing off against this inner critic that fuels depression is to practice self-compassionResearch findings have consistently shown that greater self-compassion is linked to less anxiety and depression. Despite the fact that people who suffer from depression may have lower levels of self-compassion, studies also show that practicing self-compassion can reduce symptoms of depression, in large part because it helps us not get stuck in our negative thoughts.

Dr. Kristin Neff describes three key elements of self-compassion: 1) self-kindness over self-judgment, 2) mindfulness over over-identification with thoughts and feelings, 3) common humanity versus isolation. Self-compassion asks us to value ourselves as human beings without judgment or evaluation. It allows us to notice our suffering and to feel compassion for ourselves without getting caught up in the rumination that comes with assessing ourselves or our state of being. Dr. Neff’s research has confirmed the benefits of this practice when fighting depression. One of the rewards of self-compassion is that it’s proven to better help us to achieve change in our lives.

Depression is a real disorder, but there are real ways to fight it. And when we do, no matter what treatment approach we take, we must be on our own team. We must see our critical inner voice as the enemy it is and reconnect with our real selves, the part of us that embraces our basic human right to live our lives on our terms.

By Linda Firestone, Ph.D.

Dr. Firestone is the Director of Research and Education at The Glendon Association. An accomplished and much requested lecturer, Dr. Firestone speaks at national and international conferences in the areas of couple relations, parenting, and suicide and violence prevention. Dr. Firestone has published numerous professional articles, and most recently was the co-author of Sex and Love in Intimate Relationships(APA Books, 2006), Conquer Your Critical Inner Voice (New Harbinger, 2002), Creating a Life of Meaning and Compassion: The Wisdom of Psychotherapy (APA Books, 2003) and The Self Under Siege (Routledge, 2012).

Follow Dr. Firestone on Twitter or Google.


Four Questions for a More Resilient Brain

Psychologist Elisha Goldstein writes, “When it comes to overcoming longstanding emotional struggles we have to not only get space from the self-critical mind, but also encourage the positive beliefs about ourselves that the critical mind has buried.”  He lays out four questions that can lead our minds in a more positive direction.  Read his Blog

Biology of the Binge: The Biochemical Link Between Depression and Food

Many of us have experienced the instantaneous connection between food and mood. We may find ourselves crunching nervously through bags of potato chips when under pressure for example, or slurping down containers of cool and silky chocolate ice cream in distracted attempts to soothe our sadnesses. However, while an occasional hankering for sweet or starchy “comfort foods” is both normal and expected, for some, the link between negative feelings and out of control eating is far more profound. Recent studies suggest that the suspicious overlap in symptoms of major depression and food addiction may be due to deep biochemical connections that have gone largely ignored in treatment programs until now.


The coexistence of psychiatric diagnoses and problems with appetite is shocking common. One research study concluded that approximately 80 percent of patients with binge eating disorder (BED) and 95 percent of patients with bulimia met the criteria for at least one other diagnosis outlined in the Diagnostic and Statistical Manual of Mental Disorders. Overweight men and women are 25 percent more likely to suffer from mood disorders than the rest of the population. Between 15 percent and 40 percent of patients with eating disorders also struggle with substance abuse.

Strikingly, 75 percent of patients with eating disorders also suffer from depression. For those individuals with binge eating disorder who are overweight, one study found that rates of depression are even higher than for individuals who are overweight but do not have binge eating disorder. In this particular study, researchers found that symptoms of depression led to binge eating episodes. Other studies have found that depressive symptoms, including low self-esteem, predicted increases in binge eating, demonstrating further evidence of the relationship between depression and binge eating. These results suggest that for some binge eating is a way to regulate emotion, however they also reveal that there is something more to the association between food addiction and depression than previously thoughtsomething disruptive, persistent, and physiological.

A look into the intricate neurochemical underpinnings of depression and binge eating disorder provides a clearer understanding of the biological nature of their troubling comorbidity. Interestingly, depression and food addiction both involve alterations in neurotransmitters, the substances that relay messages from one brain cell to another and then to the rest of the body. We know that imbalances in any of the neurotransmitters can wreak havoc with brain circuitry and predispose individuals to mental and physical distress. Normal levels of serotonin, the neurotransmitter linked most closely to satisfaction, lead both to emotional satisfaction and a sense of fullness after a meal. Low levels, on the other hand, can lead to depression and a tendency to binge on sweet and starchy foods. In fact, one study looking at how depression and a gene associated with lower levels of serotonin related to binge eating found that depressed children and older females who carried this gene were more likely to engage in binge eating behaviors.

In the context of a biochemical perspective on binge eating, this correlation makes sense. For some binge eating foods begins as a way to find a moment of much needed relief from depressive tendencies, and to fill the emotional void left by a lack of serotonin. However, what begins as a seemingly innocent attempt to self-soothe, quickly gives way to a complex cycle of addiction in the body. The flood of endorphins from eating large amounts of food only temporarily alters the neurochemistry of the brain, providing brief periods of solace from emotional distress; but these are not lasting. Ultimately, the demand for food intake to achieve such pacifying effects only increases over time and the coping mechanism completely fails, exacerbating instabilities with mood.

More research is needed to examine the precise mechanisms by which a serotonin deficiency can affect food, appetite, weight gain, and mood, and the causal nature of this overlap. However it is evident from the current body of scientific literature, that a holistic approach to investigating the interplay between an individual’s relationship to food and co-existing mood disorders is essential in order for successful recovery opportunities to exist. Treating one problem in isolation is not enough. It is only by comprehensively assessing the neurochemical commonalities underlying such complex psychological conditions that sustainable treatment solutions become possible.

By Stephen B. Jones, M.D., psychiatrist.

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